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Histamine-Restricted Diet

Information on this page comes from Dietary Management of Food Allergies & Intolerances: A Comprehensive Guide, by Janice Vickerstoff Joneja. 1998. J. A. Hall Publications.

• Food Sources of Histamine
• From the Urticaria Chapter
• Allowed/Restricted Foods
• Histamine Restricted Diet for Control of Urticaria/Angioedema

Food Sources of Histamine

Histamine occurs in food as a result of microbial enzymes converting the amino acid histidine (present in all proteins) to histamine. All foods subjected to microbial fermentation in the manufacturing process contain histamine. Included in this category are cheeses, fermented soy products, other fermented foods (e.g. sauerkraut), alcoholic beverages, and vinegars.

Foods exposed to microbial contamination also contain histamine in levels determined by the extent and rate of action of the microbes. Histamine levels reach a reactive level long before any signs of spoilage occur in the food. This characteristic has important implications in fin fish, where bacteria in the gut are particularly active in converting histidine to histamine. The longer the fish remains ungutted, the higher the levels of histamine in the flesh.

Some foods such as eggplant and spinach contain high levels of histamine naturally. In addition, a number of food additives such as azo dyes and preservatives mediate the release of histamine.

Some of these chemicals such as benzoates occur naturally in foods, especially fruits, and may have the same effect as the food additive in releasing histamine.

The histamine restricted diet excludes all foods known to contain high levels of histamine or to contain chemicals that can promote the physiological release of histamine.
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From the Urticaria Chapter

The foods most commonly reported to induce urticaria are shellfish, fish, egg, nuts, chocolate, berries, tomatoes, cheese, milk, and wheat.

Foods reported to release histamine directly from mast cells are uncooked egg whites, shellfish, strawberries, tomatoes, fish, chocolate, pineapple and alcohol.

Foods containing histamine—Aged protein containing foods and fermented foods commonly have increased histamine levels.

Foods reported to be high in histamine are fermented cheeses (e.g. Camembert, Brie, Gruyere, Cheddar, Roquefort, Parmesan), brewer's yeast, shellfish, many fin fish, canned fish, tomato, spinach, red wine (especially Chianti), beer, unpasteurized milk (e.g., cow, goat or human milk), chicken, dry pork sausage, beef sausage, ham, chocolate, fermented soy products, and all fermented vegetables, such as sauerkraut.
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Allowed/Restricted Foods

This diet excludes all:

• foods with naturally high levels of histamine
• fermented food
• artificial food coloring, especially tartrazine
• Benzoates including food sources of benzoates, benzoic acid and sodium benzoate
• Butylated hydroxyanisole (BHA) and butylated hydoxytoluene (BHT)

Type of Food	Foods Allowed	Foods Restricted
Milk and dairy	Plain milk Ricotta cheese	All prepared dairy products made with restricted ingredients All cheese All yogurt Buttermilk
Breads and cereals	Any pure unbleached grain or flour Any plain fresh bread, buns, biscuits, pizza dough with allowed ingredients Homemade or purchased baked cookies, pies etc made with allowed ingredients	Products made with: Anise Artificial colors Artificial flavors Bleached flour Cheese Chocolate Cinnamon Cloves Cocoa Margarine Preservatives Restricted fruits Some jams, jellies Any food made with or cooked in oils with hydrolyzed lecithin, BHA, BHT Commercial pie, pastry, and fillings Baking mixes Dry dessert mixes
	Breakfast cereals made with allowed foods, including: All plain grains Plain oats and oatmeal Plain cream of wheat Puffed rice and wheat Plain crackers with allowed ingredients: Grissol Melba toast RyVita Rye Krisp Wasa light or golden crackers	All others
	Plain pasta	All packaged rice and pasta meals
Vegetables	All pure fresh and frozen vegetables and juices except those listed	Eggplant Pumpkin Sauerkraut Spinach Tomato and all tomato products All vegetables prepared with restricted ingredients
Fruits	Apple Banana Cantaloupe (rock melon) Figs Grapefruit Grapes Honeydew Kiwi Lemon Lime Mango Pear Rhubarb Watermelon Fruit dishes made with allowed ingredients	Apricot Cherry Cranberry Currant Date Loganberry Nectarine Orange Papaya (pawpaw) Peach Pineapple Prunes Plums Raisins Raspberries Strawberries Fruit dishes, jams, juices made with restricted ingredients
Meat, poultry and fish	All pure, freshly cooked meat or poultry	All fish and shellfish All processed meats All leftover cooked meats
Eggs	All plain, cooked egg	All prepared with restricted ingredients Raw egg white (as in some eggnog, hollandaise sauce, milkshake)
Legumes	All plain legumes except those listed opposite Pure peanut butter	Soy beans Red beans
Nuts and seeds	All plain nuts and seeds	All with restricted ingredients
Fats and oils	Pure butter Pure vegetable oil Homemade salad dressings with allowed ingredients Lard and meat drippings Homemade gravies	All fats and oils with color and/or preservatives Hydrolyzed lecithin Margarine Prepared salad dressings with restricted ingredients Prepared gravies
Spices and herbs	All fresh, frozen or dried herbs and spices except those listed opposite	Anise Cinnamon Cloves Curry powder Hot paprika Nutmeg Seasoning packets with restricted ingredients Foods labeled "with spices"
Sweeteners	Sugar Honey Molasses Maple syrup Corn syrup Icing sugar Pure jams, jellies, marmalades, conserves made with allowed ingredients Plain artificial sweeteners Homemade sweets with allowed ingredients	Flavored syrups Prepared desert fillings Prepared icings, frostings Spreads with restricted ingredients Cake decorations Confectionary Commercial candies
Miscellaneous	Baking powder Baking soda Cream of tartar Plain gelatin Homemade relishes with allowed ingredients	All chocolate and cocoa Flavored gelatin Mincemeat Prepared relishes and olives Soy sauce Miso Commercial ketchup Gherkin pickles Most commercial salad dressing
Beverages	Plain milk Pure juices of allowed fruits and vegetables Plain and carbonated mineral water Coffee Alcohol: plain vodka, gin, white rum	Flavored milks Fruit juices and cocktails made with restricted ingredients All other carbonated drinks All tea All drinks with "flavor" or "spices" Beer Wine Cider All other alcoholic beverages

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Histamine Restricted Diet for Control of Urticaria/Angioedema

Do not eat the following food during the 4 week trial elimination period.

Meat/Poultry/Fish

• All seafood including shellfish or fin fish, fresh, frozen, smoked or canned
• Egg (a small quantity in a baked product such as pancakes, muffins, cakes is usually tolerated)
• Processed, smoked and fermented meats such as luncheon meat, sausage, weiner, bologna, salami, pepperoni
• Leftover meat: eat freshly cooked meat ONLY (side note from Jackie—After meat is cooked, the histamine levels increase due to microbial action as the meat sits.)

Milk and Milk Products

• All fermented milk products, including cheese (any milk product that is curdled rather than fermented is allowed, such as cottage cheese, ricotta cheese and panir)
• Cheese products such as processed cheese, cheese slices, cheese spreads
• Yogurt, buttermilk, kefir

Fruits and Vegetables

• Orange
• Grapefruit
• Lemon
• Lime
• Cherries
• Strawberries
• Raspberries
• Cranberries
• Loganberries
• Apricot
• Pineapple
• Dates
• Raisins
• Prunes
• Currants
• Relishes
• Pickles
• Spinach
• Tomatoes
• Ketchup
• Tomato sauces

Food Additives

• Tartrazine and other artificial food colors
• Preservatives, esp. benzoates, sulfites and BHA, BHT

Note: Many medications and vitamin pills contain these additives, especially colors. Ask the pharmacist to recommend additive-free supplements and medications.

Seasonings

• Cinnamon
• Chili powder
• Cloves
• Anise
• Nutmeg
• Curry powder
• Hot paprika (cayenne)

Miscellaneous

• Fermented soy products
• Fermented food
• Tea—herbal or regular
• Chocolate, cocoa, and cola drinks
• Alcohol
• Vinegar and foods containing vinegar such as pickles, relishes, ketchup, and prepared mustard

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